The predictors of the presence of varices in patients with primary sclerosing cholangitis

Sombat Treeprasertsuk, Kris V. Kowdley, Velimir A C Luketic, M. Edwyn Harrison, Timothy McCashland, Alex S. Befeler, Denise Harnois, Roberta Jorgensen, Jan Petz, Jill Keach, Jeff Schmoll, Tanya Hoskin, Prabin Thapa, Felicity T Enders, Keith D. Lindor

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Abstract

The predictors for developing varices in patients with primary sclerosing cholangitis (PSC) have not been well studied prospectively. We sought to define the predictors for the presence of varices at baseline and for newly developing varices in patients with PSC. We used prospectively collected data from a multicenter randomized trial of high dose ursodeoxycholic acid for PSC. All 150 patients enrolled were reviewed for predictors of varices and we excluded 26 patients who had esophageal varices at baseline so that predictors of newly developing varices could be determined. Clinical examination, blood tests, and upper endoscopy were done before randomization, at 2 years and after 5 years. Liver biopsy was performed at entry and at 5 years. The median age (interquartile range) of patients was 45.9 years (35.8, 54.9). In amultivariable logistic regression, a higher Mayo risk score (≥0.87) or a higher aspartate/alanine aminotransferase (AST/ALT) ratio (>1.12) were significantly associated with the presence of varices at initial endoscopy (odds ratio=1.9 and 3.9). By the end of the study, 25 patients had new varices (20.2%). In a Cox model, after adjustment for baseline variables lower platelet count and higher total bilirubin at 2 years were significantly associated with the presence of new varices. The platelet count of 205 (×109/L) and the total bilirubin level of 1.7 mg/dL were the best cutoff values for the detection of new varices. Conclusion: A higher Mayo risk score and higher AST/ALT ratio were significantly associated with the presence of varices at initial endoscopy. Lower platelet count and higher total bilirubin at 2 years were significantly associated with an increased risk of developing new varices in patients with PSC.

Original languageEnglish (US)
Pages (from-to)1302-1310
Number of pages9
JournalHepatology
Volume51
Issue number4
DOIs
StatePublished - Apr 2010

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Sclerosing Cholangitis
Varicose Veins
Platelet Count
Bilirubin
Endoscopy
Aspartate Aminotransferases
Alanine Transaminase
Ursodeoxycholic Acid
Esophageal and Gastric Varices
Hematologic Tests
Random Allocation
Proportional Hazards Models
Multicenter Studies
Logistic Models
Odds Ratio

ASJC Scopus subject areas

  • Hepatology

Cite this

Treeprasertsuk, S., Kowdley, K. V., Luketic, V. A. C., Harrison, M. E., McCashland, T., Befeler, A. S., ... Lindor, K. D. (2010). The predictors of the presence of varices in patients with primary sclerosing cholangitis. Hepatology, 51(4), 1302-1310. https://doi.org/10.1002/hep.23432

The predictors of the presence of varices in patients with primary sclerosing cholangitis. / Treeprasertsuk, Sombat; Kowdley, Kris V.; Luketic, Velimir A C; Harrison, M. Edwyn; McCashland, Timothy; Befeler, Alex S.; Harnois, Denise; Jorgensen, Roberta; Petz, Jan; Keach, Jill; Schmoll, Jeff; Hoskin, Tanya; Thapa, Prabin; Enders, Felicity T; Lindor, Keith D.

In: Hepatology, Vol. 51, No. 4, 04.2010, p. 1302-1310.

Research output: Contribution to journalArticle

Treeprasertsuk, S, Kowdley, KV, Luketic, VAC, Harrison, ME, McCashland, T, Befeler, AS, Harnois, D, Jorgensen, R, Petz, J, Keach, J, Schmoll, J, Hoskin, T, Thapa, P, Enders, FT & Lindor, KD 2010, 'The predictors of the presence of varices in patients with primary sclerosing cholangitis', Hepatology, vol. 51, no. 4, pp. 1302-1310. https://doi.org/10.1002/hep.23432
Treeprasertsuk S, Kowdley KV, Luketic VAC, Harrison ME, McCashland T, Befeler AS et al. The predictors of the presence of varices in patients with primary sclerosing cholangitis. Hepatology. 2010 Apr;51(4):1302-1310. https://doi.org/10.1002/hep.23432
Treeprasertsuk, Sombat ; Kowdley, Kris V. ; Luketic, Velimir A C ; Harrison, M. Edwyn ; McCashland, Timothy ; Befeler, Alex S. ; Harnois, Denise ; Jorgensen, Roberta ; Petz, Jan ; Keach, Jill ; Schmoll, Jeff ; Hoskin, Tanya ; Thapa, Prabin ; Enders, Felicity T ; Lindor, Keith D. / The predictors of the presence of varices in patients with primary sclerosing cholangitis. In: Hepatology. 2010 ; Vol. 51, No. 4. pp. 1302-1310.
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AU - Kowdley, Kris V.

AU - Luketic, Velimir A C

AU - Harrison, M. Edwyn

AU - McCashland, Timothy

AU - Befeler, Alex S.

AU - Harnois, Denise

AU - Jorgensen, Roberta

AU - Petz, Jan

AU - Keach, Jill

AU - Schmoll, Jeff

AU - Hoskin, Tanya

AU - Thapa, Prabin

AU - Enders, Felicity T

AU - Lindor, Keith D.

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N2 - The predictors for developing varices in patients with primary sclerosing cholangitis (PSC) have not been well studied prospectively. We sought to define the predictors for the presence of varices at baseline and for newly developing varices in patients with PSC. We used prospectively collected data from a multicenter randomized trial of high dose ursodeoxycholic acid for PSC. All 150 patients enrolled were reviewed for predictors of varices and we excluded 26 patients who had esophageal varices at baseline so that predictors of newly developing varices could be determined. Clinical examination, blood tests, and upper endoscopy were done before randomization, at 2 years and after 5 years. Liver biopsy was performed at entry and at 5 years. The median age (interquartile range) of patients was 45.9 years (35.8, 54.9). In amultivariable logistic regression, a higher Mayo risk score (≥0.87) or a higher aspartate/alanine aminotransferase (AST/ALT) ratio (>1.12) were significantly associated with the presence of varices at initial endoscopy (odds ratio=1.9 and 3.9). By the end of the study, 25 patients had new varices (20.2%). In a Cox model, after adjustment for baseline variables lower platelet count and higher total bilirubin at 2 years were significantly associated with the presence of new varices. The platelet count of 205 (×109/L) and the total bilirubin level of 1.7 mg/dL were the best cutoff values for the detection of new varices. Conclusion: A higher Mayo risk score and higher AST/ALT ratio were significantly associated with the presence of varices at initial endoscopy. Lower platelet count and higher total bilirubin at 2 years were significantly associated with an increased risk of developing new varices in patients with PSC.

AB - The predictors for developing varices in patients with primary sclerosing cholangitis (PSC) have not been well studied prospectively. We sought to define the predictors for the presence of varices at baseline and for newly developing varices in patients with PSC. We used prospectively collected data from a multicenter randomized trial of high dose ursodeoxycholic acid for PSC. All 150 patients enrolled were reviewed for predictors of varices and we excluded 26 patients who had esophageal varices at baseline so that predictors of newly developing varices could be determined. Clinical examination, blood tests, and upper endoscopy were done before randomization, at 2 years and after 5 years. Liver biopsy was performed at entry and at 5 years. The median age (interquartile range) of patients was 45.9 years (35.8, 54.9). In amultivariable logistic regression, a higher Mayo risk score (≥0.87) or a higher aspartate/alanine aminotransferase (AST/ALT) ratio (>1.12) were significantly associated with the presence of varices at initial endoscopy (odds ratio=1.9 and 3.9). By the end of the study, 25 patients had new varices (20.2%). In a Cox model, after adjustment for baseline variables lower platelet count and higher total bilirubin at 2 years were significantly associated with the presence of new varices. The platelet count of 205 (×109/L) and the total bilirubin level of 1.7 mg/dL were the best cutoff values for the detection of new varices. Conclusion: A higher Mayo risk score and higher AST/ALT ratio were significantly associated with the presence of varices at initial endoscopy. Lower platelet count and higher total bilirubin at 2 years were significantly associated with an increased risk of developing new varices in patients with PSC.

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